Clear Aligner Attachments Made Easy
by Michael Howard
Clear aligner therapy is an impressive and increasingly popular development in modern dentistry. Using a series of appliances that exert gentle, consistent pressure, clear aligner systems stimulate osteoclastic and osteoblastic processes that move teeth into place, improving dental appearance and function. Compared to traditional methods such as braces, clear aligners enable patients to remedy simple orthodontic issues and achieve optimal esthetics more conveniently and discreetly.
Despite these advantages, implementing clear aligners isn’t without significant challenges, especially when it comes to attachments. Sometimes referred to as “buttons” or “engagers,” orthodontic attachments are constructed with composite resin and adhered to tooth surfaces. Depending on tooth size, shape and the desired amount of movement, attachments are generally required so that aligners can achieve adequate “grip” and perform as intended. However, proper attachment placement can be tedious, while removal risks damaging underlying enamel. Furthermore, over time, attachments sometimes display poor esthetics due to bonding agent yellowing and may even lose effectiveness as the composite material wears down. This results in negative treatment outcomes and diminishes patient satisfaction. Thankfully, Shofu Dental Corporation offers a full suite of solutions that address these common concerns and more.
After referencing your treatment plan and completing the phosphoric etch process on uncut enamel, BeautiBond® bonding agent can be applied to the tooth surface. Unlike many other products, BeautiBond will not produce residual staining over time, making it ideal for use on anterior teeth. Once you’ve allowed the material to sit undisturbed for 10 seconds, gently blow dry the area for 3 seconds, strongly for another 2–3 seconds, and light cure (either 10 seconds for a halogen curing light or 5 for an LED).
To create the attachment, use Beautifil Flow Plus® X, a flowable composite available in a zero flow viscosity (F00). This material features optimal qualities for attachment creation—Beautifil Flow Plus X is stackable and sculptable, and has exceptional handling, esthetics and wear resistance. What really sets Beautifil Flow Plus X apart, however, is Giomer Technology, a bioactive system derived from a proprietary filler particle engineered by Shofu. Giomer Technology restoratives release and recharge 6 beneficial ions including fluoride, strontium, sodium, aluminum, silicate, and borate. Together, these ions are clinically proven to deliver sustainable plaque-fighting, acid-neutralizing abilities that support long-term therapeutic benefits not available in competitive products.
After thoroughly drying the aligner, slightly overfill the attachment well (template window) with Beautifil Flow Plus X. Fully seat the loaded template onto the patient's teeth and, using a dental instrument, apply gentle pressure around each attachment—this ensures full adaptation and squeezes excess composite away from the etched area. Next, firmly hold down the composite with an instrument and light cure—20 seconds for halogen or 10 for LED—before removing the aligner. Lastly, remove all flash and bonding resin between teeth and floss interproximal areas. Once you have finished polishing the attachments, you are free to place the first aligner.
With Shofu products, removing attachments is just as safe and easy as placing them. Begin by using visualization software like Align’s ClinCheck® to determine the exact location of the patient’s attachments. Then, define the outlines of each attachment with a sharp pencil before using the Black-Course Super-Snap disk, manufactured without a metal center to easily remove the bulk of the attachment. For this step, use a slow speed of approximately 10,000 rpm. After the outer two-thirds of the attachment have been removed, switch to the enamel-safe OneGloss PS single-step polisher and use light pressure at 10,000–12,000 rpm until the pencil marks are completely gone. Both of the aforementioned Shofu products are disposable. Once you see a uniform material-tooth interface and the margins are no longer visible, you’ll know you have successfully removed the attachment.
To learn more about simplifying attachments with Shofu and order solutions for your practice, visit their website.
ClinCheck is a trademark of Align Technology, Inc.